Comments on: Dr. WhiteCoat Goes to Washingtonhttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/
A blog from inside the emergency departmentThu, 26 Mar 2015 23:22:27 +0000hourly1http://wordpress.org/?v=4.1.1By: Free Market Transparency on the Horizon? | WhiteCoat's Call Roomhttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21565
Sat, 29 May 2010 10:49:46 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21565[…] Now THIS is what I’m talking about! […]
]]>By: Matthttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21383
Tue, 25 May 2010 01:51:47 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21383If we go to single payer like you suggest, much of this is moot. You want Mexico malpractice laws, give us Mexico medical prices. And physician salaries.
]]>By: Matthttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21382
Tue, 25 May 2010 01:50:15 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21382You misread. I think physicians deserve every dollar I get. In fact, I think some of you seriously undervalue yourselves as you allowed yourselves to get paid in lockstep with all other physicians, regardless of skills.

I support your ability to earn as much as the market will bear.

]]>By: DensityDuckhttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21375
Tue, 25 May 2010 00:01:54 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21375“skin in the game”: No. That isn’t the problem, actually, because people having their cars repaired have plenty of “skin in the game” and yet car repairs are still plenty pricey. (And medical patients don’t have the option to total the car and buy a new one…)

You say “skin in the game”, but I keep thinking that what’s really going to happen is that there’ll be just as much defensive medicine, only now it’ll be used as an excuse to insulate doctors from ANY malpractice accusations–Matt’s nightmare scenario. “I think you need this test, even though your insurance won’t pay for it. But if you don’t get the test and something goes wrong, then you can’t sue me, because you Didn’t Do The Recommended Test.”

It seems to me that the better path would be to institute a national board in the USA, similar to Mexico’s CONAMED or other such bodies, that would review prospective malpractice cases before they went to trial. Indeed, the very notion of “expert witnesses” argues against the competence of twelve general-population citizens to decide medical matters; why not just carry that to its logical conclusion?

]]>By: DensityDuckhttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21373
Mon, 24 May 2010 23:50:08 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21373I love how we’ve got a lawyer here bitching about how doctors make too much money!
]]>By: DensityDuckhttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21371
Mon, 24 May 2010 23:46:21 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21371“You also say that health insurance shouldn’t cover routine care. What about routine care that is a public good?”

There’s plenty of precedent for this. Many states require drivers to have their vehicles inspected every year. This inspection is performed at the driver’s expense, even though it’s notionally to ensure a base level of “health” in all vehicles on the road.

Even without that, regular vehicle maintenance (oil changes, tire rotation, brake inspection) reduces the number of accidents; and those accidents are responded to, typically, by government personnel. Seems to me that there’s a “public good” argument that basic vehicle maintenance should be covered, and yet those costs are still borne by the drivers themselves.

As for single-payer, it could certainly reduce costs by instituting a Schedule Of Approved Treatment and anything outside that is at the patient’s own option–and the patient’s own risk. “Well, Mister Medical Examiner, I did the Approved Treatment and the patient still died, blame the government for the wrong Approved Treatment. I asked the patient if he wanted more, but he didn’t want to pay the extra fee to cover the liabilty costs.”

]]>By: DefendUSAhttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21340
Mon, 24 May 2010 14:32:06 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21340WC, Great job, but Mattuendos drive me berserk!! Argh!!
Your suggestion about skin in the game is spot on. I think I have said it before that people think it’s magic when they make a copay and they are done. Actually most of your thoughts are worthy of consideration by those who make the laws. Let’s hope you get a call back.
]]>By: Matthttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21123
Fri, 21 May 2010 22:52:17 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21123I think all of that is exactly where we are headed. Plus I expect physician pay to decline significantly.
]]>By: Joehttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21118
Fri, 21 May 2010 20:57:39 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21118How is a patient supposed to determine whether or not a particular test is “low yield”? The doctor has an incentive to over-test (as you correctly noted), so asking the doc is out. Do you really want your patients second-guessing you when you order expensive but necessary tests?

I mean, you already have patients second-guessing you about vaccination, right?

I lean towards the single-payer end of the spectrum, so the problem of reducing unnecessary testing seems fairly easy: any doc who orders substantially more than average “low yield” tests (taking into account the number and types of patients they see) would receive a professional audit by an MD. The auditor would suggest ways to reduce testing; docs who can’t manage to reduce testing would have their reimbursement reduced.

You also say that health insurance shouldn’t cover routine care. What about routine care that is a public good? What about routine care that in the long run reduces catastrophic care, saves the insurance company money, and reduces hospital overcrowding?

As for malpractice reform, I think we just plain need to stop handling non-malicious malpractice in the courtroom. Docs who screw up a bit (as determined by a review board of other doctors) should be required to take remedial training; those who screw up big-time should lose (or have restrictions placed on) their licenses. Injured patients should be provided remedial care out of a government fund, but no punitive damages or awards for pain and suffering. Seeing a doctor, like anything else in life, entails some risk; trying to make whole those who are injured in doing so ends up drastically reducing the quality of care for everybody. Doctor liability should be limited to those rare cases when the doc commits a criminal act.

]]>By: Matthttp://www.epmonthly.com/whitecoat/2010/05/dr-whitecoat-goes-to-washington/#comment-21114
Fri, 21 May 2010 19:23:10 +0000http://www.epmonthly.com/whitecoat/?p=4848#comment-21114More on the Faustian bargain made by health insurers:

It’s likely going to turn out similar to the Faustian bargain physicians made 30 or so years ago with LBJ. Although at least physicians had a few decades of making quite a bit of money off of it. I don’t think health insurers will get that long before the spigot gets shut off.